(Re)activation of survival strategies during pregnancy and childbirth following experiences of childhood sexual abuse

Abstract

Objectives: To explore the pregnancy and childbearing experiences of women-survivors of childhood sexual abuse [CSA]. We aimed to generate a theory explaining those experiences for this population (women), this phenomenon (pregnancy and childbirth), and this context (those who have survived CSA). Method: Participants (N=6) were recruited to semi-structured interviews about their experiences of CSA and subsequent pregnancy and childbirth. Data saturated early, and were analysed using Grounded Theory (appropriate to cross-disciplinary health research). Coding was inductive and iterative, to ensure rigour and achieve thematic saturation. Results: Open and focused coding led to the generation of supercategories, which in-turn were collapsed into three distinct, but related themes. These themes were: Chronicity of Childhood (Sexual) Abuse; Pregnancy and Childbirth as Paradoxically (Un)safe Experiences; Enduring Nature of Survival Strategies. The relationship between these themes was explained as the theory of: (Re) activation of Survival Strategies during Pregnancy and Childbirth following Experiences of Childhood Sexual Abuse. Conclusion: Pregnancy and childbirth can be triggering for women-survivors of CSA. Survival strategies learnt during experiences of CSA can be (re)activated as a way of not only coping, but surviving (the sometimes unconsented) procedures, such as monitoring and physical examinations, as well as the feelings of lack of control and bodily agency.

Inside the ‘imperfect mosaic’: Minority ethnic women’s qualitative experiences of race and ethnicity during pregnancy, childbirth, and maternity care in the United Kingdom

“…Under-represented women’s perinatal mental health has been at the centre of much previous research [ 11 , 42 , 46 , 47 ], with fear of stigma often arising as the predominant reason for non-disclosure. Similar to previous work [ 48 – 50 ], findings from the present study suggest that essential steps to care which is being personalised to women’s needs may be perinatal mental health staff within maternity services, as well as positive relationships initiated by midwives and other healthcare professionals.…”

“…Participants did not need to have experienced discrimination to anticipate it when coming into contact with maternal health services, which reflects previous research stating that anticipated inequality of treatment can lead to distrust in the service [11,37,42,48,50]. As found with healthcare professionals in the 'Imperfect Mosaic' theory, lack of authenticity and humility resulted in a disconnect between cultures and religions; and women often highlighted an increased likelihood of disclosing and trusting healthcare staff from minority ethnic backgrounds.…”

“…Pregnant women and birthing people are inherently not sick, nor are they inherently vulnerable. Their queries must be addressed throughout antenatal and postnatal care by provision of high-quality, accessible, and culturally sensitive information on how to navigate the complex maternity system, to enable empowerment, informed decision-making, and avoidance of poor labour and birthing experiences [ 50 ].…”

Sensitive, Challenging, and Difficult Topics: Experiences and Practical Considerations for Qualitative Researchers

“…There can be pressure to report first time disclosures (Silverio et al, 2020) which presents significant ethical issues. Control is of paramount importance to survivors of CSA and taking control from a participant risks re-enacting abuse (Montgomery et al, 2015b; Roberts et al, 2021).…”

“…Sensitive, challenging, or difficult areas of empirical inquiry can encompass a myriad of topics, from the seemingly benign to the deeply intrusive, intimate, or morbid. Such topics may include: Bereavement (Buckle et al, 2010; Stroebe et al, 2003), death and dying (Glaser & Strauss, 1965; Owens & Payne, 1999), suicide (Dyregrov et al, 2011; Gibson et al, 2013), illness or pain (Duncan et al, 2009; James & Platzer, 1999), disability (Banas et al, 2019; Nuwagaba & Rule, 2015; Wilkenfeld, 2015), abuse (Burgess-Proctor, 2015; Roberts et al, 2021; Silverio et al, 2020), trauma (Gooberman-Hill et al, 2011; Newman et al, 2006), race (Edwards, 1990; Few et al, 2003), sexuality and sexual activity (Gledhill et al, 2008; Seal et al, 2000), and ‘non-normative’ lifecourses (Hampshire et al, 2014; Wahab, 2003). This list is, of course, not exhaustive.…”